HomeMy WebLinkAboutMortgage_Miller"'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun wn ' Year
_ FOR DEDUCTION FROM ASSESSED VALUATION
• . :• Sfata Fam 43709 (R17 16-09)
��w Presaibetl M�rtmeM a( Loml GwemmeR Fi�nce 1,^
INSiRUCT10NS: 'n~�;I
Fartn fded wBh:
k be filed in person w by mail wiN the CountyAuditor or Counry Recorder o/ the counry where tM1e property is located.
FiTing Dates: 1 J Real PropeAy: Must fJe durirg the year for which the dedudion is so�ghG '�' Auditor
2) Mobiie / Manufectured Homes rrot assessed as Real Property: Must file dunng the tweHe (72) monfhs n�I
6elore March 31 o/each year the deduction is sought GIBSO COU u er
See reverse side tw additional instructions arM qualificafions.
MP��� (owner moon�cjbuyer- s9e r� YlnrlAns q'� re�rrse vde) ./\n A
M`i::l
/ her ena share ot interest?
8=�3 -� 40�! -0c7o• D:
Mortgage / Contraa in0ebteEness unpaid as W
Marrh 1, artem ye� � e _ 1
m remrd is tlifferent Nan Ihat ot appOcant, trMifate 6elow
Name of rmt8a9m or wntrau
Address of nwrtga9ec or
spaeG �QY.
holder W mortgage
udebtednnss imGaid as d
tlate
❑ Yes
rc m�a �m �� w�r ma, �. maira� wm �
Is the property in Questim: MnuaDy As�sed
❑ Real Properry ❑ Armually Assessed
�t av9gnee (number and stree; ary, state. end LP ooCe) "
tinm wm P�P�Y in any aha � �7� NC/C /y� �� �a� . Has this deEUCi
InEiana? ❑ Ye5 ❑ No ��J/�/� � /��1�'�' forcurtentyeaR
DeGUCUOn appravatl c� ttre amount
2� _ 2f1.
Si9(aaue d Counb a�dnar
�l�//-839
No
ste0 rn proprity
Yes ❑ No
�Date (rtanM. daY. Y�A
I/ We certiy under the penalry of perjury that the ahove arW fomgoing infwmation is we and cortect arM that the applirant is a resident of IrMiana aMl
owner I contraG buyer ot the aforemeMioned property on date application is filed.
. _ pf/�9�/ l
d1 app1GCa'nt (nu`mbe^r ar-M street, tity, state, and ZIP cd
�� �aa�ror�E Yorcri� �.i-iz-0.�
person (number aM sLee; dty, s7ale. erM Z!P wtle)
Date (nmfi, day, yea�
�_ Z8—l�
yea�
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